Neonatal contrasted-MRI showed communication between the tumor and the transverse sinus, and thus sinus pericranii was diagnosed.
Complete resection of the lesion was successfully performed at 6 months of age.
Discussion:
As sinus pericranii usually presents in adults, little is known about events leading to its congenital presentation. In fact, to our knowledge, these are the first prenatal ultrasound images of this anomaly.
Sinus pericranii is usually located in the midline and often in the frontal region[13], but parietal, temporo-occipital[14] and mastoid bone[15] locations have also been described.
This diagnosis is difficult to make clinically, because the skin manifestations are highly variable and may resemble other disorders of the scalp and cranium. They can even present as dilated scalp veins (and not a patent tumor!!!), due to altered venous drainage of sagittal sinus blood. Concomitant symptoms are rare, although some patients complain of headache, nausea and vertigo[16]. A clue for diagnosis is the acute distention of the mass with the Valsalva maneuver and its complete disappearing when the patient is in sitting position[17]. Spontaneous regression has occasionally been reported[18].
Definitive diagnosis can be made through angiography and percutaneous sinography but contrasted MRI is the gold standard[19],[20].
Complications include: hemorrhage, infection, and air embolism.
Management: Surgical removal is recommended and is usually easy. When the sinus is small, the flow within the mass is slow there is no significant communication with the cerebral veins, endovascular sclerosis may be advocated.
References:
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[18] Hayakawa I, Fujiwara K, Sasaki A, Hirata T, Yanagibashi K, Tsuchida T. Spontaneous regression of sinus pericranii--report of a caseNo Shinkei Geka 1978 Jan;6(1):91-5
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